Failing implant before prosthetic overdenture: treatment options?

The failing implant needs to be removed. If you are going to try to have 2 implants support an overdenture in the mandible (which is a questionable treatment plan), then they need to be located in the sites of the canines.

I often explain to my patients that their treatment will never be easier or less costly than if they proceeded TODAY. I would ask you what you would do for your child in this situation. I would not wait for complete failure, but explant, graft and replace the implant intra-foramen region (#22 area). While remaining alveolar bone can dictate where you place implants, it still should be fundamentally sound. In a 2 implant retained overdenture, the widest separation possible is critical to disperse forces and provide balanced retention. If you are in doubt, than either a scan or surgical exploration of the alveolus should be undertaken in order to determine placement or candidacy for ridge augmentation.

I believe the implant should be removed and replaced. Couple of words of advice, make sure you know where the prosthetic teeth will be and how much room you have vertically. DrT, I disagree with your comment regarding the mandibular overdenture. Two implants is the standard of care recommendation by the American College of Prosth for patients wearing lower dentures; nothing questionable about it. Location of two implants in the anterior mandible is best determined by the tooth position and arch form. It is important to avoid an anterior cantilever by placing them too far back, especially in tapering or U-shaped arches. Standard placement in the canine position is not advised as it is arbitrary without consideration of the arch and it also limits future implant placement near the foramina should the patient wish to progress to a future fixed prosthesis. I treatment plan all edent mandibles for at least four implants to support a hybrid prosthesis and then have my surgeon place the two anterior if the patient chooses the overdenture. This way I have not limited their options down the road.

actually, two implants in the anterior mandible is a great treatment option. Often quoted as the "standard of care" vs. a complete mandibular denture in a toronto study. I like the implants in 23 and 26 especially when using locators so the denture does not rock around the implants. If the implants are further posterior, ball abutments often are a better choice since they offer more freedom of movement to decrease the risk of fulcruming around the attachments. Simply place a new implant in the 23 site.

Remove the failing implant asap. Place a new implant into the same site after grafti9ng if needed or distal to it in the canine position. Mini implants can be placed if the bone allows. The mini implants can provide immediate stabilization and function for the patient, as well as protect the larger diameter implants while they heal. The mini implants can remain as a part of the final restoration or they may be removed later if desired. Do not wait for more bone to be lost.

Hard to make recommendations without radiographs/photographs. But let's start with a couple of key questions. First, what is the mode of failure? Was this a two stage procedure where the patient wore a denture over the healing areas? If this is a microtrauma related peri-implantitis, removing and replacing will probably result in the same outcome. Second, is there adequate attachment around the implant, or is there alveolar mucosa or frenum attachment at the implant neck? If so, soft tissue needs to be addressed prior to implant revision. But here is a suggestion. If it is purely a microtrauma related bone loss, make the attachment to the current denture to get stability, and then graft the lesion. If you are adept at treating this type of peri-implant problem, if you stabilize the prosthesis you will have a decent chance at repair. RJM

I would like to see radiographs and photos. If a mandibular denture is in service. There may be occlusal load from the denture onto the implants. Relieve said load and graft if possible.

Ever since the Toronto Conference dentists have been debating the placement of the two recommended implants in the mandible. Many don't limit the treatment to two but place three or four to avoid mechanical problems. The information presented in this case is too limited; therefore, to suggest a cause and a solution would just be speculation. If one wants to leave open the option to later place a fixed restoration then conventional implants are the treatment of choice for the over denture. Otherwise all the debate regarding the number, location, bone quality and quantity etc. are mute. Twenty-five plus years ago, much to the disappointment of my OMS and lab tech, I started doing all of these removable lower denture cases using mini implants. The success rate approximates conventional implants with fewer maintenance problems, shorter treatment time, less cost and fewer treatment planning debates. Patients like the results. I have no involvement w/ any company.

Dr T. Two root forms in the anterior mandible supporting an overdenture is not a questionable treatment plan! There are times this option is all the patient can afford and it serves them very well.

Agree with two implants around canine sites are good enough. Extract implant and place another at canine's. But Before you do that, make sure the patient has not have treatment with bisphosphonates. Descart BIONJ first; even before removing that implant!!! Just in case

Wow many spirited comments without a film to evaluate. I would like to know if the patient was wearing a denture over the newly placed implants, if it is not relieved that can lead to bone loss and failure. The implants when healed will provide additional retention while the denture is still tissue supported, if the old unbalanced plate is in there it could be one issue. The anterior mandible can be tricky especially in the incisor area which can be thin, dense and not very vascular. I like to have a working diagnosis of why the implant may have failed. I also like to consider A-P spread when placing the implants to help avoid cantilevers. What is the prosthetic plan? Locators? Bar? Anyway the short answer is remove the implant since it is early in the process and try to re-evaluate the treatment plan so you don't lose too much money on this case. I would not advise grafting and trying to salvage this implant. Welcome to the world of surgery. Good luck and thanks for reading!!

I had a case that was an exception in my practice.the patient was a 60 years old female with 2 implant in area 45&46,she had a severe bone loss arround these implants I decide to remove both and replace it,when I perform a flap I saw about 5 mm bone loss around 2 implants,but unbelievable! I could not remove these implants they was really osseointegrated!after removing about 4 mm of bone with hand piece they were still hard in situation they were still in place with only 2 mm in bone !i hope the implant became loose!so I did not remove the whole lingual plate for my future gbr ,they are still in the area after one month with no sign of mobility like a real ankylosis!

Is the patient a male or female? Do they brux? What meds are they taking? What is there overall systemic health? Do they smoke? How much bone is available on the facial? What is the age and medical Hx? How did one prepare the osteotomy? These are some questions that should come to mind! Typically early failures are due to overheating the bone, osteonecrosis, infection, occlusal trauma, and poor primary stability to name a few.